Intracameral ketorolac concentration at the beginning and end of cataract surgery following preoperative topical ketorolac administration

Abstract

Purpose

To evaluate the intracameral concentration of ketorolac tromethamine (ketorolac) at the beginning and end of cataract surgery following preoperative topical administration.

Setting

Santa Barbara Surgery Center, Santa Barbara, CA, USA.

Design

This was a pre–post, interventional, single-arm study.

Patients and methods

Patients undergoing cataract extraction and lens replacement (CELR) were eligible. Written informed consent was obtained from 14 patients who were prescribed topical ophthalmic ketorolac according to the surgeon’s usual practice beginning the day prior to surgery. The surgeon withdrew 100 μL of aqueous humor from the operative eye immediately prior to the initial surgical incision and again just prior to final anterior chamber reinflation and wound closure. Ketorolac concentrations in the intracameral fluid samples were measured.

Results

Thirteen of 14 patients used four doses of ketorolac the day prior to surgery as directed, and one patient used three doses. On the day of surgery, all 14 patients administered one drop of topical ketorolac on awakening and one drop after arriving at the surgery center. Preoperative ketorolac concentrations for the 12 patients from whom samples were collected ranged from 4.9 to 369 ng/mL. End-of-procedure sample concentrations ranged from <1.0 (the lower limit of quantification [LLOQ]) to 6.32 ng/mL, with eight of 12 patients having ketorolac levels below the LLOQ.

Conclusion

At-home compliance with topical ketorolac was good, with 92.9% of patients using it as directed. Following CELR, levels of ketorolac in the aqueous humor were low, and 66.7% of patients had undetectable levels.

Keywords:

• cataract surgery
• NSAIDs
• ketorolac
• topical administration
• intracameral drug concentration

Acknowledgments

This study was funded by Omeros Corporation, Seattle, WA, USA. This work was presented as a poster at the American Society of Cataract and Refractive Surgery – American Society of Ophthalmic Administrators Symposium & Congress, San Diego, CA, USA, April 17–21, 2015.

Disclosure

DA Katsev and J Pinnow are consultants for Omeros Corporation and J Pinnow holds an equity interest in Omeros. CM Lockhart is an employee of Omeros Corporation. CC Katsev has no financial interest in the subject matter of this manuscript. The authors report no other conflicts of interest in this work.